The Brief

For customers using a telehealth website to get cheaper versions of popular obesity drugs, the low prices turned out to be too good to be true.

Customers of Zappy Health tell NPR they were drawn to the online provider by its low prices, its lack of subscription fees and its handy smartphone app with a chat feature for patients to talk to one another during their weight-loss journeys.

The Zappy chat was ultimately how many customers first learned that Ousia Pharmacy — one of several pharmacies that supplied Zappy with compounded obesity drugs — didn't have a required license, one that ensured the drugs were produced in accordance with safety and potency standards.

Compounded drugs that Zappy and other telehealth sites sell aren't generics. Instead, they're essentially copies of the name-brand drugs, made by specialized pharmacies. The Food and Drug Administration allows this kind of compounding during drug shortages.

Compounding pharmacies are regulated at the state level. Ousia, in Spring Hill, Fla., didn't have what's called a sterile compounding license. The obesity drugs made by compounding pharmacies are given by injection, so attention to sterile production is critical to avoid contamination that could cause infections.

Zappy didn't find out about Ousia's licensing problem until December and it ceased its roughly three-month relationship with the pharmacy on Dec. 13, Zappy's founder, Dr. Michel Choueiri, told NPR in an email after a broadcast version of this story aired. He called Zappy "the biggest victims of this situation" and said that it has left the company in "severe financial and reputational ruin."

Some Zappy customers NPR spoke with found out about the problem on Reddit.

Laura Franzese, in Portland, Ore., learned about the licensing problem after spending $1,000 on a bulk order of tirzepatide from Zappy that arrived with Ousia labels. (Tirzepatide is the active ingredient in Eli Lilly's obesity drug Zepbound.) She'd been taking the drugs already, from a local provider, and called them "life-changing," but made the switch to Zappy hoping to save money.

"I bought three months' worth of medicine from this company," she says. Now she's afraid to use the drugs. "It was a big investment."

People active on Reddit told NPR that Zappy deleted the original user post in its app chat forum about Ousia's lack of the proper license. Choueiri says Zappy publicly apologized in the same forum and removed the post only while it was verifying the claim.

Ousia couldn't be reached for comment.

When Laura Franzese started with compounded tirzepatide at a local medical spa, she lost 20 pounds in 16 weeks. "It's giving me something that my body clearly needed," she says. But it was expensive. She discovered she could get a lower price from Zappy Health.

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Laura Franzese

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For many people who've turned to online telehealth companies to find compounded obesity drugs, they say they would prefer to take the brand-name drugs, but it isn't an option for them. They say Novo Nordisk's Wegovy and Eli Lilly's Zepbound aren't covered by their insurance. And paying the full sticker price — more than $1,000 a month — is too expensive.

Compounding pharmacies fill a gap for patients like this. They've been a part of the health care landscape for decades, preparing custom medicines for people who need them, but booming demand for weight-loss drugs — as well as resulting brand-name shortages — has brought them into new prominence.

Even some people who have health insurance coverage for obesity drugs say they turn to telehealth and compounding because they couldn't reliably find the brand-name drugs in local pharmacies.

But the situation with Ousia shows the pitfalls of navigating the world of online compounded obesity drugs, which includes legitimate businesses as well as some unlicensed or unregistered ones. It can be difficult for consumers to tell the difference or trust the quality of the obesity drugs they're buying.

Looking for a deal, finding confusion

For Zappy customers, the problems came as a surprise.

Eric Bishop, an IT professional in Salt Lake City, was looking for a way to buy more tirzepatide at once, fearing that the official end to the Zepbound shortage would mean the end of the compounded version. He had been filling his prescription at a local brick-and-mortar compounding pharmacy but turned to Zappy to buy a stockpile.

He didn't know which pharmacy would be fulfilling the order through Zappy until after he paid. "They didn't give me a choice," he says.

Bishop had just gotten his nine-month supply of tirzepatide, worth $2,700, from Zappy when users on the Zappy app blew the whistle on Ousia.

"That's when I started seeing things in the chat," he says of the app's patient forum feature. "So I bounced over to Reddit."

According to a complaint filed by the Florida Department of Health on Dec. 5, Ousia applied for a sterile compounding license in March 2024, but it was never granted. When state regulators inspected the facility later that year in August, they discovered that it was compounding medicines anyway. In addition, inspectors noted that Ousia was improperly storing drugs that needed to be refrigerated and not keeping proper records for drugs it dispensed.

The Florida Department of Health did not respond to requests for comment on this story. In an email to NPR, Zappy's founder, Choueiri, said the department failed to disclose Ousia's problem "in a timely manner."

Bishop couldn't believe what he was reading.

"I'm all of a sudden, you know, about ready to start taking my medication and I'm like, I now no longer have any confidence in what I have," Bishop says. "And I might either want my money back or I want a replacement for what I have."

Eric Bishop helps run a Facebook group for people who got Ousia vials from Zappy Health and are trying to get their money back. Since Ousia gave up its regular pharmacy license on Jan. 31, he says, some people have been more successful.

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Courtesy Eric Bishop

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Another Zappy patient, Nicole Drong, in Minneapolis, says she was surprised when vials marked "Ousia" arrived at her home. "I did not know the name of the pharmacy until I got a package. And I was like, 'Well, that's weird. I thought it was going to say 'Zappy' on it.'"

Then in December, she noticed the Zappy app was sending her a lot more notifications than usual from the patient forum. Word was out that Ousia didn't have a sterile compounding license.

"I kind of feel stupid, I guess," Drong says. She says she was " just blindly putting trust in this pharmacy. … How often do you ever have to double-check your medication? Like, if I go get my antidepressants from Walgreens, do I have to double-check to make sure there's not anything extra in my bottle of pills?"

Choueiri, Zappy's founder, says patients have the opportunity to cancel once they learn which pharmacy is fulfilling their order, and it has responded to patient feedback to be more transparent with customers up front.

Confusion and no refunds

The bureaucratic details of licensing can be opaque to consumers. But these licenses matter, says Scott Brunner, who leads the trade group of compounding pharmacists, the Alliance for Pharmacy Compounding. Ousia pharmacy wasn't a member, he says.

He called not having a sterile compounding license where one is required "egregious."

"I would not take a drug that has been dispensed to that patient from a pharmacy that has been found to be in violation of its state license law," he says.

Choueiri did a TikTok live on Jan. 15, where he said Zappy was "made aware of the complaint" and wanted to let the process play out. He added that his family members were taking the Ousia medications too and that he was also fielding questions from them.

"It's not counterfeit?" he said, reading questions as they came in. "Yeah, no. No, it's not counterfeit. Um no, no. The short answer is no, but I'm not going to go down the legal litigation here."

At first, Zappy told people they could fill out a Google form to get a refund or replacement vials, but customers tell NPR that nothing has come of it yet. For a time, Zappy also told customers to ask Ousia for a refund instead.

On Jan. 31, 2025, Ousia voluntarily relinquished its regular pharmacy license, Florida records show. Now, the pharmacy's phone number goes to voicemail and its website is down.

Asked what Zappy is now advising its patients to do with their Ousia vials, Choueiri wrote to NPR: "As always, Zappy is a platform that connects patients to affordable care but does not replace the role of medical providers or pharmacists. Decisions about medication use should always be made in consultation with a licensed healthcare professional, and defer these conversations to the providers of care."

Zappy Health ads on Facebook and Instagram promote its weight-loss program, which involves connecting patients to online providers and sending them low-cost obesity drugs made by compounding pharmacies.

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Zappy/Images screenshot and compiled by NPR

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Choueiri is a medical doctor. On its website, Zappy touts that its weight-loss plans "are personalized by doctors."

According to Zappy's terms of service, the doctor-patient relationship isn't between Zappy and its users. It's between the providers who do virtual appointments and prescribing on Zappy and the Zappy customers. And the company "disclaims any liability for the medical or pharmaceutical services provided through its platform."

Spotting red flags

While the Ousia situation is unfortunate for the patients involved, it's an example of the regulatory system working the way it's supposed to, says Brunner.

The National Association of Boards of Pharmacy says it's hard to know how many online retailers are offering compounded obesity drugs that are made without the proper license or registration. State pharmacy boards oversee most compounding pharmacies around the U.S., but if a pharmacy isn't registered or licensed in a state where it's shipping products, it can be hard to track.

Betty Jones, compliance senior manager of the accreditation and inspection programs at NABP, says consumers can protect themselves by looking out for red flags. For instance, you should always know which pharmacy is filling your prescription, and they're required to provide counseling.

"If they're not providing you that offer of patient counseling or you're calling into that pharmacy and they don't allow you to, you know, be progressed to a pharmacist where you can ask questions, that would be something that I would call a red flag."

She says prices that are too low and pharmacies that don't ask for a prescription should also trigger alarm bells.

Potential customers should also be able to verify that a pharmacy is licensed, since these are public records available online in most states. And to dispense to you, that means the pharmacy needs to be licensed in your state, too — not just the one where it's located.

Bishop, the Zappy customer in Salt Lake City, says he helped organize a Facebook group for people to help them figure out how to get their money back. Customers say they haven't been able to get refunds.

Choueiri says Zappy's low prices mean it doesn't have much money left over after paying pharmacies and providers, and "Zappy does not control the funds necessary to issue refunds."

The Facebook group has grown to more than 600 people. Its members have even helped report new information to the Florida Department of Health, Bishop says. "We're just a community just kind of helping each other out."

Many of the group members' banks initially declined to reverse their credit card transactions with Zappy. That has started to change since Ousia relinquished its license, Bishop says. "Actually, some banks are even opening disputes that they closed previously."

Zappy is still advertising to customers, but Bishop says he isn't buying from the company again. He's back on compounded tirzepatide from his local pharmacy.
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The case: In September, the city settled a lawsuit brought forward by two brothers in their 70s who said they suffered serious injuries after an LAPD officer crashed into their car. Days before the $18 million settlement was reached, lawyers for the brothers said Feldstein Soto called an expert witness testifying for the plaintiffs and “attempted to ingratiate herself with him and asked him to make a contribution to her political campaign,” according to a sworn declaration to the court by the plaintiffs’ attorney, Robert Glassman.

The response: Feldstein Soto did not respond to an interview request. Her spokesperson said the settlement “had nothing to do” with the expert witness. Her campaign manager told LAist the city attorney had been making a routine fundraising call and did not know the person had a role in the case, nor that there were pending requests for her office to pay him fees.

What Jurado says: In a statement to LAist, Jurado said she wants to “make sure that the city’s legal leadership is guided by integrity and accountability, especially when their choices affect public trust, civic rights and the city’s limited resources."

What’s next: The motion needs to go through a few committees before reaching the full City Council. If it passes, the motion calls for the city attorney to “report to council in closed session within 45 days regarding the ethics breach violation and give updates to the City Council."

Every year in Santa Ana, Luis Cantabrana turns the front of his home into an elaborate altar in honor of La Virgen de Guadalupe that draws hundreds of visitors.

Along the front of the house, the multi-colored altar is filled with lights, flowers and a stained-glass tapestry behind a sculpture of the Lady of Guadalupe. Cantabrana’s roof also is lit up with the green, white and red lights that spell out “Virgen de Guadalupe” and a cross.

Visitors are welcomed with music and the smell of roses as they celebrate the saint, but this year’s gathering comes after a dark year for immigrant communities.

Luis Cantabrana stands in front of the stunning altar he built in front of his home in honor of La Virgen de Guadalupe. Every year, his display draws hundreds of visitors.

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Destiny Torres

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LAist

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Why do they celebrate? 

In 1513, the Virgin Mary appeared before St. Juan Diego between Dec. 9 and Dec. 12, asking him to build a church in her honor. Her image — a brown-skinned woman wearing a green veil with her hands together in prayer and an angel at her feet — miraculously appeared on his cloak.

To celebrate in Santa Ana, worshippers gathered late-night Wednesday and in the very early hours Dec. 12 to pray the rosary, sing hymns and celebrate the saint.

Cantabrana has hosted worshippers at his home for 27 years — 17 in Santa Ana.

The altar started out small, he said, and over the years, he added a fabric background, more lights and flowers (lots and lots of flowers).

“It started with me making a promise to la Virgen de Guadalupe that while I had life and a home to build an altar, that I would do it,” Cantabrana said. “Everything you see in photos and videos is pretty, but when you come and see it live, it's more than pretty. It's beautiful.”

The Santa Ana home's elaborate altar in honor of La Virgen de Guadalupe draws hundreds of visitors each year.

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Destiny Torres

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LAist

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Gathering in a time of turmoil 

Many also look to the Lady of Guadalupe for protection, especially at a time when federal enforcement has rattled immigrant communities.

“People don’t want to go to work, they don’t want to take their kids to school, but the love we have for our Virgen de Guadalupe,” Cantabrana said. “We see that la Virgen de Guadalupe has a lot of power, and so we know immigration [enforcement] won’t come here.”

Margarita Lopez of Garden Grove has been visiting the altar for three years with her husband. She’s been celebrating the Virgencita since she was a young girl. Honoring the saint is as important now as ever, she said.

“We ask, and she performs miracles,” Lopez said.

Claudia Tapia, a lifelong Santa Ana resident, said the Virgin Mary represents strength.

“Right now, with everything going on, a lot of our families [have] turned and prayed to the Virgen for strength during these times,” Tapia said. “She's a very strong symbol of Mexican culture, of unity, of faith and of resilience.”

See it for yourself

The shrine will stay up into the new year on the corner of Broadway and Camile Street.

California’s unemployment agency kept paying cellphone bills for 4 1/2 years without checking whether its workers actually were using the devices.

That’s how it racked up $4.6 million in fees for mobile devices its workers were not using, according to a new state audit detailing wasteful spending at several government agencies.

The Employment Development Department’s excessive cellphone bills date to the COVID-19 pandemic, when it shifted call center employees to remote work and faced pressure to release benefits to millions of suddenly unemployed Californians.

It acquired 7,224 cellphones and wireless hotspots by December 2020. State auditors analyzed 54 months of invoices since then and found half the devices were unused for at least two years, 25% were unused for three years and 99 of them were never used at all.

The investigation, which auditors opened after receiving a tip, identified 6,285 devices that were unused for at least four consecutive months, and said the department spent $4.6 million on monthly service fees for them.

From the beginning, the department had about 2,000 more cellphones than call center employees, according to the audit. The gap widened over time after the pandemic ended and the department’s staffing returned to its normal headcount.

As of April, the audit said the department had 1,787 unemployment call center employees, but was paying monthly service fees for 5,097 mobile devices.

“Although obtaining the mobile devices during COVID-19 may have been a good idea to serve the public, continuing to pay the monthly service fees for so many unused devices, especially post-COVID-19, was wasteful,” the audit said.

Department officials told auditors they were unaware of the spending, but auditors pointed to regular invoices from Verizon that showed which phones were not being used.

“We would have expected EDD management to have reconsidered the need to pay the monthly service fees for so many devices that had no voice, message, or data usage,” the audit said.

The unemployment department began acting on the auditors’ findings in April, when it canceled service plans for 2,825 devices. It has since implemented a policy to terminate service plans for devices that go unused for 90 days.

The California state auditor highlighted the mobile devices in its regular report on “improper activities by state agencies and employees.” The audit also showed that the California Air Resources Board overpaid an employee who was on extended leave as he prepared to retire by $171,000.

This article was originally published on CalMatters and was republished under the Creative Commons Attribution-NonCommercial-NoDerivatives license.